Mental Health Collaborative Dementia Summary of Activity October 2010 The following extracts provide either one example of a Board s dementia improvement activity or a brief summary of a Board s current and planned activities in dementia; further details are available from their local programme manager or identified lead. The aim of these summaries is to support collaboration between Boards by enabling you to identify who else is working on something of interest to you and then make contact to share ideas. Ayrshire & Arran A full time CPN Charge Nurse has been appointed till March 2011 to work with Primary Care colleagues to support the reconciliation of updated primary and secondary care data and to reinforce the comprehensive diagnosis and registration processes that have been developed. An additional 0.6wte Liaison Nurse has been temporarily appointed to work with Care Homes in Ayrshire to support staff in the assessment process of individuals considered to have an unconfirmed diagnosis, and to support staff in the early identification and screening of residents with a suspected diagnosis of dementia. Process mapping exercises have been undertaken with Admin and Clerical staff where a specific number of service improvements were identified and implemented. CMHTS recording the range of information provided to people post diagnosis and later this year will be auditing and evaluating feedback provided. In collaboration with Alzheimer Scotland auditing the uptake and actual use of Alzheimer Helpline cards, which Community Pharmacists across Ayrshire are now routinely issuing whenever they are dispensing dementia related medication and to all other known individuals/carers. A range of awareness raising and educational programmes have been made available to General Hospital staff, with the further development of a suitable algorithm to assist in the early identification and screening of people with suspected dementia (will also be used with Care Home staff). A number of Dementia champions have also been identified within one general hospital, with regular support provided by Liaison staff. The intention is to replicate aspects of this in other general hospital areas. Early exploratory work underway around local opportunities to develop through the pro-learn (e-learning programme), modular training based on effective screening, diagnosis, and care and support of people with dementia and their carers. Has potential to reach many staff groups. Data analyst currently working with primary care colleagues to develop and refine future search process re supporting primary care staff in identifying and registering people with dementia. Links established with Practice Education Facilitator who supports a number of Care Homes where Student Nurses are on placement. MHC planning to provide PDSA workshops to Student Nurses and their mentors from Care Homes.
Planning a Pathway review event with Long Term Condition Collaborative and Mental Health Service colleagues. The aim is to promote the sharing of information with All Ages SPARRA data, so that people with a known dementia can have the same review arrangements currently in place for people with other long term conditions, applied consistently. Planning to pilot and evaluate enhanced joint 15 month review arrangements between primary and specialist services in one particular GP Practice area PLT event planned for mid November, when Dementia will be featured. Further range of information leaflets distributed to all GP practices in Ayrshire with details for re-ordering supplies provided. Planning to host a World Café event in Irvine in November specifically for people affected by dementia, including individuals with dementia, their carers, nursing care home, general hospital, social work and volunteer support staff. The intention is to involve 100 people from a variety of backgrounds to engage and share in meaningful conversations about dementia, encouraging personal and professional commitments to be made as a result of discussion. A number of information stalls and resources will be available at the event. Further details are available from anne.gerard@aapct.scot.nhs.uk NHS Borders Developed Primary Care Guideline on the Diagnosis and Management of Dementia in Primary Care. Face to face training being delivered to GP Practices to support implementation of the Primary Care Dementia Guideline. As part of the training session, primary care and specialist care are agreeing liaison arrangements. Outwith training sessions, reconciling specialist and primary care dementia data. This includes cross referencing information from our Learning Disability Dementia Service. Outwith training sessions, focussed work in care homes to identify people with diagnosis who are not on the Primary Care Register. Testing the use of proxy measures in two practices to measure impact on registers. Working with Primary and Community Services to link other general practice staff into raising awareness of dementia. Auditing SMR01 information with actual confirmed diagnoses in acute setting. Early stages of applying DCAQ tool in one specialist Older Adult Team. Further details are available from pauline.burns@borders.scot.nhs.uk NHS Dumfries & Galloway Lists have been generated from care homes of residents with dementia or a suspected diagnosis & from the acute hospital of patients discharged with a diagnosis of dementia. Both lists cross-referenced to CMHT & Memory clinic information resulting in a comprehensive list to be compared to GP dementia registers across each locality. This information will be disseminated to all practices during October & November. Fifty two multidisciplinary staff have attended end of life care training and a working group will be established to take forward the report recommendations. A copy of the report is available on request.
Training has been completed across the region with CMHT & Care Home staff on interventions to respond to challenging behaviour. Further training is planned for mental health ward, acute and community hospital staff. The 1 st training cohort is being evaluated & training materials are available on request. A plan for a three tiered approach to challenging behaviour is now proposed and in the early stages of implementation. This will involve consolidation of the above training with further information being provided for GPs and Social Services. As part of this process recommendations on the use of anti-psychotic medications will be provided for GPs which will link into the completed audit of the use of antipsychotic medication for dementia sufferers. A survey in Stewartry continues to establish service user opinions around the current review process. Information provided at the Memory Clinic in one locality is being audited with the intention of rolling this out to all localities on completion. Further details are available from Linda.mckechnie@nhs.net NHS Fife Developing Guidance on 15 month review; proposing an elearning package to include this guidance. Further details are available from Seonaid.McCallum@faht.scot.nhs.uk Surveying professionals and carers involved in dementia care to benchmark information given at each stage of pathway. Further details are available from MikeKelly@nhs.net / kimrobertson@nhs.net Exploring use of an existing database already used by one team; creating a portal for other old age services to adopt and import their information into. Further details are available from MikeKelly@nhs.net / mo.ahmed@nhs.net Collaborating on the development of a pathway redesign event between old age psychiatry and elderly medicine service. Further details are available from MikeKelly@nhs.net / Seonaid.McCallum@faht.scot.nhs.uk Proxy measure feedback encouraging. Clinical pharmacists in 1 CHP cross checked patients prescribed Dementia medication with dementia register yielding 23 patients to be included on dementia register. Planning to roll out this proxy measure to all other CHP s. Further details are available from MikeKelly@nhs.net NHS Forth Valley A&E dementia pathway has been devised and implemented ensuring clear referral routes for diagnosis and management. Develop Advanced Care Plans for people recently diagnosed with dementia in conjunction with the ICP. Local protocol applied to the implementation of ACPs. Post diagnostic information checklist fully implemented in one CHP area, to be developed further in the other 2 CHPs. The checklist ensures a gold standard approach to information given for service users and carers. Regarding dementia register work, community mental health services and 38 GP practices have cross referenced their lists against each other. (This work continues to progress).
Process map undertaken in one practice with a high number on their register to further develop the care pathway. A full review of Older people s community mental health services using improvement methodology is underway to build capacity for future care provision. Integrated care ward an acute medical/mental health ward has been built in the new Forth Valley Royal Hospital. The pilot for this ward commences in October 2010, and this will ensure a better pathway to care for service users with Dementia who are acutely medically unwell. Further details are available from linda.mcauslan@nhs.net NHS Grampian Information sharing between Primary and Secondary care contributed largely to NHS Grampian meeting the Dementia HEAT target. This was achieved by developing close links with practice managers through cluster meetings where information was shared in relation to the target and tools available including the dementia calculator, searches on incorrect coding, dementia drugs and care homes was disseminated. We are currently developing and focussing on our current Patient Management databases in order to add ICP diagnosis to all open referrals, in preparation for the new PMS launch next year. A Dementia education event for Primary Care was held in September 2010. This has resulted in closer collaborative working with our Primary Care colleagues. This collaboration continues as we develop our referral pathways in addition to the development of a local Dementia toolkit for GP s to support the Dementia review process. Further details are available from William.cowling@nhs.net NHS Greater Glasgow & Clyde Leaflets and posters including a booklet 10 Questions to Consider: A Guide for General Practitioners to assist in managing patients with dementia circulated to all GPs. Further details are available from Jill.carson@nhs.net Continuing to work with CHCP Clinical Directors and HEAT Leads to encourage GPs to record diagnosis on QOF register. Monthly chart produced displaying the no s diagnosed by CHCP, and each CHCP receives a breakdown of numbers diagnosed by GP practice. Further details are available from Mike.grimmer@ggc.scot.nhs.uk Volunteer Information Awareness project (delivered by Alzheimer Scotland) to raise awareness of dementia and provide information/advice in GP surgeries and community locations. Agreed information pack offered to patients/carers on diagnosis by CMHT staff. Information Strategy to be developed to ensure streamlined process across NHSGG&C for accessing information. Distributed leaflet Communicating with Someone who has Dementia: 12 Helpful Hints to all NHSGG&C staff and all Glasgow City Council staff through payslips. Organising distribution to staff in all other local authority partners. Further details are available from Jill.carson@nhs.net DVD of the play Changed Days has been filmed, and a launch is taking place on 25 th November.
Further details are available from Julia.mccrum@ggc.scot.nhs.uk Working collaboratively with AHP Dementia Consultant to develop extensive action plan related to work within the Acute sector. This includes ward based training resources & links with Dementia champions in Rehabilitation & Assessment wards to improve in-patient care of dementia sufferers. In addition to joint working with community teams, liaison & ward staff to develop effective discharge planning for patients with a diagnosis of dementia. A website has been developed, accessible to public and staff, giving updates and information on dementia focused activities in NHSGG&C. Regular Shared Practice Events are held to allow sharing of initiatives across the area. Further details are available from Jill.carson@nhs.net NHS Lanarkshire The PDSA approach to identify people known by Mental Health services to have a diagnosis of dementia and compare with those recorded on GPs Dementia Registers is now complete. The same process has now been completed in an additional Locality and is near completion in another Locality. The process will be applied to all GP practices within the remaining 5 Localities by November 2010. Dementia Resource Folder published and awareness training completed by Practice Development Centre and staff from Mental Health services. Awareness pack will be shared for use by partner agencies. Initial audit of core information distributed post diagnosis has resulted in 100% compliance with Coping With Dementia, 100% compliance with Power of Attorney: A Brief Guide and 87.5% compliance with information relating to driving. The future distribution of the core information has been included within the variance analysis of the Dementia ICP. A standardised covering letter to aid the GPs and practice mangers to ensure those people who have been diagnosed with Dementia by the CMHTs are recorded on the GPs Dementia Registers has been developed and implemented by the medical secretaries. An audit tool is being developed to measure the local use of the standard letter and the completion of coding within PiMS. A total of 6 homes have been identified to take part in the pilot care home audit. The aim of the audit is to evidence the accurate diagnosis rate for patients in Nursing, Residential and Dementia Units. An Audit tool has been devised to gather the required information and will be analysed and reported on after completion of all areas. We aim to identify the review process carried out individually by GPs and CMHTs for those patients with a diagnosis of Dementia. We hope to develop a standard practice of review that reduces duplication, maintains and improves the quality of a review and identifies the responsibilities of each discipline involved in the review. Further details are available from Karen.Spiers@lanarkshire.scot.nhs.uk / Gail.Notman@lanarkshire.scot.nhs.uk / May.McGowan@lanarkshire.scot.nhs.uk
NHS Lothian A Dementia PLT Event was held in May and was attended by approximately 200 GP s and clinical staff. The event focussed on: o Why GP s might wish to give a diagnosis to a patient with early dementia o The best ways to support patients and carers o How crises can be avoided, or at least best managed o The role of medication, including acetylcholinesterase inhibitors and antipsychotics o What impact dementia has on acute hospital services Feedback from the event has been positive and a similar event is scheduled for East Lothian staff in October. Our clinical lead continues to attend GP rep and practice visits through Lothian with the aim of improving dementia care. Further details are available from John.Gordon@wlt.scot.nhs.uk Pharmacist engaging with care homes on antipsychotic medication review. A brief scoping study is being implemented to review patients in one care home initially to determine appropriateness of antipsychotic medication. Initial findings will help to identify key actions that should be undertaken, and inform the appropriateness, impact and resource requirements to roll this out further across Care Homes in NHS Lothian. Further details are available from Kerrie.Buhagiar@nhslothian.scot.nhs.uk Commenced implementation of the Lothian Dementia ICP by piloting certain key elements including: o Use of standardised review incorporating the Revised Memory & Behaviour Checklist and the Functional assessment staging of Alzheimer s disease. o Piloting use of dedicated clinic to undertake 6 monthly reviews o Use of standardised information packs. Planned actions include implementation of other key ICP elements (e.g. advanced care planning, recording of variance & outcomes) and embedding dementia ICP as part of planned Older Peoples service re-design. Further details are available from Richard.Murray@nhslothian.scot.nhs.uk NHS Shetland 50% of practices visited to promote use of Dementia calculator and to carry out coding checks on GP system. Coding checks identified patients with known or suspected dementia; these will be followed up for review / assessment by GPs. Further details are available from alan.murdoch@nhs.net NHS Tayside Following meetings with older adult CMHT where data on GP Practice position was shared, the CMHT leaders agreed to discuss with the GP Practices a range of activities to identify if people who have a diagnosis of dementia are recorded on the Practice register. These activities include: o Comparing list from secondary care of those prescribed anticholinesterase inhibitors with the Practice registers. o Comparing Consultant clinic lists & diagnosis with the Practice register. o Comparing CPN lists & diagnosis with the Practice registers.
GP lead(s) identified to drive improvement work. This will include implementing a system to ensure newly diagnosed patients are consistently recorded on the Practices registers. Further details are available from Caroline.Paterson2@Scotland.gsi.gov.uk NHS Western Isles Working with Alzheimers Scotland, community awareness days held in the more remote and rural parts of Lewis and Harris to raise awareness and provide information regarding dementia. Monthly information on how all practices are compared to the target is sent to all practice managers. Planned work - AHPs are developing a template for flagging to GPs if they see a patient they suspect has dementia. Planned work - validating home care clients with a dementia diagnosis against the GP register. Further details are available from anne.hutchison2@nhs.net